Welcome to the ESPNIC Xperience Programme Scheduling
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HYDROCORTISON, VITAMINS & CO - JUST ANOTHER MAGIC BULLET MISSING THE TARGET?
CRITICALLY ILL CHILDREN TREATED WITH BETA-LACTAM ANTIBIOTICS - HOW TO IDENTIFY PATIENTS AT RISK FOR SUBOPTIMAL EXPOSURE AND CLINICAL FAILURE?
Abstract
Background and Aims
In critically ill children, severely altered pharmacokinetics often result in subtherapeutic antibiotic concentrations. However, it remains unclear how to recognize those patients most at risk for suboptimal exposure and outcome data are lacking. This study aimed to identify risk factors for target non-attainment and clinical failure in critically ill children treated with beta-lactam antibiotics.
Methods
This observational cohort study included critically ill children aged 1 month to 15 years, treated intravenously with amoxicillin-clavulanic acid, piperacillin-tazobactam or meropenem. Steady-state trough plasma concentrations were considered therapeutic if ≥ MIC of the (suspected) pathogen. Risk factors for subtherapeutic concentrations and clinical failure were identified by logistic regression analysis. Clinical failure was defined as insufficient lessening of signs and symptoms and the need for alternate antimicrobial therapy.
Results
382 trough concentrations were obtained from 157 patients (median age 1.25 years, Q1 0.4; Q3 4.2). Subtherapeutic concentrations were measured in 75.0%, 97.9% and 61.2% of patients treated with amoxicillin-clavulanic acid, piperacillin-tazobactam and meropenem, respectively. eGFR (p <0.001) and the absence of vasopressor treatment (p=0.026) were found as independent predictors of target non-attainment, whilst log transformed CRP was significantly related to clinical outcome (p=0.049). An association between antibiotic concentrations and clinical failure (22.9%) was not observed.
Conclusions
Subtherapeutic β-lactam antibiotic concentrations are common in critically ill children and correlate with renal function. Commonly used eGFR equations are helpful in daily practice to identify patients who require higher doses. Future studies should focus on dose optimization and evaluation of its effect on clinical outcome.
ASSOCIATION OF INTRAVENOUS IMMUNOGLOBULINS PLUS METHYLPREDNISOLONE VS IMMUNOGLOBULINS ALONE WITH COURSE OF FEVER IN MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN (MIS-C)
Abstract
Background and Aims
Multisystem Inflammatory Syndrome in Children (MIS-C) is the most severe pediatric form of SARS-CoV-2 infection, but the optimal therapeutic strategy remains unknown. Our aim was to compare intravenous immunoglobulins (IVIG) plus methylprednisolone versus IVIG alone as initial therapy.
Methods
Retrospective cohort study, comparing IVIG plus methylprednisolone and IVIG alone, with propensity score matching analysis based on a national surveillance system. All cases with suspected MIS-C were reported to the French National Public Health Agency. Confirmed MIS-C cases fulfilling the WHO definition were included.
The primary outcome was persistence of fever 2 days or recrudescence of fever within 7 days, which defined treatment failure. Secondary outcomes included a second-line therapy, hemodynamic support, and acute left ventricular dysfunction after first-line therapy. The primary analysis involved propensity score matching with a minimum caliper of 0.1
Results
We have included 111 children. Overall, 3/34 (9%) children in the IVIG and methylprednisolone group and 37/72 (51%) in the IVIG alone group failed treatment. Treatment with IVIG and methylprednisolone was associated with lower risk of treatment failure (absolute risk difference -0.28, 95% CI -0.48 to -0.08, p=.008). IVIG and methylprednisolone therapy was also significantly associated with less use of second-line therapy (absolute risk difference -0.22, 95% CI -0.40 to -0.04, p=.004], hemodynamic support (absolute risk difference -0.17, 95% CI -0.34 to -0.004) and acute left ventricular dysfunction occurring after initial therapy (absolute risk difference -0.18, 95% CI -0.35 to -0.01).
Conclusions
Combined treatment with methylprednisolone vs IVIG alone was associated with better course of fever in children with MIS-C.
THERAPEUTIC PLASMA EXCHANGE IN CRITICALLY ILL CHILDREN.
Abstract
Background and Aims
Therapeutic plasma exchange(TPE) is a method of extracorporeal blood purification involving the removal of inflammatory mediators and antibodies.The aim of the present study was to describe the indications,technical aspects, and adverse events associated with the procedure in critically ill pediatric patients.
Methods
Data were collected retrospectively from medical records of patients who underwent TPE in the PICU of “Aghia Sophia” Athens Children’s Hospital between 2011 and 2020.
Results
The analysis involved 81 plasmapheresis procedures in 15 patients.Median age: 11 years(2-15). Female/Male: 9/6. The diseases treated with plasmapheresis included: myasthenia gravis(4), autoimmune encephalitis(2), transverse myelitis(1), Guillain-Barre syndrome(2),progressive multifocal leukoencephalopathy PML(1), thrombotic thrombocytopenic purpura(2), autoimmune hemolytic anemia(1), acute severe hyperlipidemic pancreatitis(1), kidney transplant rejection(1).Category I indications were 54%.There was a median of 5 sessions per patient (1-8). Per session volume exchanged was 1-1.5 the calculated plasma volume. Replacement fluids were human albumin 5% plus Fresh frozen plasma(FFP). 5 patients were immunosuppressed /oncologic patients. The most common adverse side effects observed during plasma filtration were hypocalcemia(28%),which was easily corrected, and hypotension(6%). Monitoring of pre and post-exchange serum fibrinogen levels showed that they remained normal or unremarkably reduced in the majority of cases where FFP was used along with albumin. No central venous catheter-related bloodstream infection was reported.Clinical improvement was noted in 87%of patients and no death occurred.
Conclusions
TPE can be considered a relatively safe, feasible and well tolerated method of treatment in the PICU setting. Outcome in children requiring TPE alone is excellent.
THE REEMERGING PROFILE OF PERTUSSIS IN BRAZIL AND ITS IMPACT ON CHILDREN’S AND TEENAGER’S HOSPITALIZATION
Abstract
Background and Aims
Pertussis is an acute bacterial infectious disease responsible for high rates of infant morbidity and mortality, despite the national vaccination program, which concerns the public health agencies. The objective of this study is to analyze the epidemiological profile and behavior of pertussis hospitalizations in Brazil and point out the importance of health surveillance.
Methods
Data were collected using the Hospital Information System (SIH). The study population were children and teenagers from zero to 14 years old diagnosed with pertussis from 2007 to 2020 in Brazil. The variables analyzed were hospitalizations and deaths throughout the years, age group and hospitalization time.
Results
In the period analyzed, 22. 279 pertussis hospitalizations were reported among children. The highest number of hospitalizations (87.51%) and deaths (92.68%) were registered among those under 1 year old, also responsible for 90.08% of the total hospitalization time. Over the years, was verified a significant increase in hospitalizations, with the highest number registered in 2014 and a decrease from 2020.
Conclusions
Despite the systematic vaccination of children started in the 1980s, pertussis has been showing a reemerging profile in Brazil. This scenario appears to be related to genotypic changes in bacteria, a greater number of asymptomatic carriers and improvement in laboratory diagnosis. This is an alarming context, especially to children under 1 year of age, vulnerable to a serious and fatal infection. Therefore, is important to monitor the disease through epidemiological surveillance to aid strategies in education and access to health through public policies.